The Govt of Bangladesh is presently planning to modify the current IMCI guideline. The modified guideline recommends that treatment of all severe pneumonia cases without danger signs unless there is another severe classification will be done at the first level facility. In 2004 the Govt. of Bangladesh in collaboration with ICCDR,B carried out a pilot study in rural Bangladesh (Chowdhury, El Arifeen et al. 2008) to assess the safety and effectiveness of a modified IMCI clinical management guideline for children with severe pneumonia aged 2months - 5 years. The study concluded that appropriate management of severe pneumonia at local level could not only save lives but represent a major cost decrease through reduction of referral, treatment and admission costs. Another research conducted in Pakistan, a randomized equivalency trial revealed that community management of pneumonia through home treatment with high-dose oral amoxicillin was just as effective as current hospital based treatments for severe pneumonia (Hazir et al. 2008). Although all of these findings are very encouraging, none of the study really focused on the immediate outcomes of the IMCI such as improved care seeking, adherence of the health providers and household caregivers to the algorithmic protocol and understanding the barriers and facilitators to the use of this protocol. Moreover, these studies were conducted in controlled research settings and therefore do not provide adequate understanding of the challenges and potential of implementing IMCI in routine health systems. So there is need to carry out research in actual community settings to understand what components of this modified guideline will work in 'real life situations' taking into account all the challenges and constraints faced by health systems of developing countries like Bangladesh.